INTRODUCTION Borderline personality disorder (BPD) is a severe and prevalent psychiatric disorder. Mentalization-based therapy (MBT) is an evidence-based intervention for BPD, and several countries offer treatment programs for BPD lasting for years, which is resource demanding. No previous trial has compared short-term with long-term MBT. OBJECTIVE The aim of the study was to assess the efficacy and safety of short-term versus long-term MBT for outpatients with BPD. METHODS Adult outpatients (≥18 years) with subthreshold or diagnosed BPD were randomly assigned (1:1) to short-term MBT (5 months) or long-term MBT (14 months). The primary outcome was BPD symptoms assessed with the Zanarini Rating Scale for Borderline Personality Disorder. Secondary outcomes were functional impairment, quality of life, global functioning, and severe self-harm. All outcomes were primarily assessed at 16 months after randomization. This trial was prospectively registered at ClinicalTrials.gov, NCT03677037. RESULTS Between October 4, 2018, and December 3, 2020, we randomly assigned 166 participants to short-term MBT (n = 84) or long-term MBT (n = 82). Regression analyses showed no evidence of a difference when assessing BPD symptoms (MD 0.99; 95% CI: -1.06 to 3.03; p = 0.341), level of functioning (MD 1.44; 95% CI: -1.43 to 4.32; p = 0.321), quality of life (MD -0.91; 95% CI: -4.62 to 2.79; p = 0.626), global functioning (MD -2.25; 95% CI: -6.70 to 2.20; p = 0.318), or severe self-harm (RR 1.37; 95% CI: 0.70-2.84; p = 0.335). More participants in the long-term MBT group had a serious adverse event compared with short-term MBT (RR 1.63; 95% CI: 0.94-3.07; p = 0.088), primarily driven by a difference in psychiatric hospitalizations (RR 2.03; 95% CI: 0.99-5.09; p = 0.056). CONCLUSION Long-term MBT did not lead to lower levels of BPD symptoms, nor did it influence any of the secondary outcomes compared with short-term MBT.

中文翻译：

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边缘型人格障碍的短期与长期基于心理化的治疗：一项随机临床试验 （MBT-RCT）。


引言 边缘型人格障碍 （BPD） 是一种严重且普遍的精神疾病。基于心智化的疗法 （MBT） 是一种针对 BPD 的循证干预措施，一些国家提供持续多年的 BPD 治疗计划，这需要大量资源。以前的试验没有比较短期和长期 MBT。目的 该研究的目的是评估短期与长期 MBT 对门诊 BPD 患者的疗效和安全性。方法 将低于阈值或诊断为 BPD 的成人门诊患者 （≥18 岁） 随机分配 （1：1） 至短期 MBT （5 个月） 或长期 MBT （14 个月）。主要结局是使用 Zanarini 边缘型人格障碍评定量表评估的 BPD 症状。次要结局是功能障碍、生活质量、整体功能和严重自伤。所有结局在随机分组后 16 个月主要评估。该试验前瞻性地在 NCT03677037 ClinicalTrials.gov 注册。结果 在 2018 年 10 月 4 日至 2020 年 12 月 3 日期间，我们将 166 名参与者随机分配到短期 MBT （n = 84） 或长期 MBT （n = 82） 组。回归分析显示，在评估 BPD 症状（MD 0.99;95% CI：-1.06 至 3.03;p = 0.341）、功能水平（MD 1.44;95% CI：-1.43 至 4.32;p = 0.321）、生活质量（MD -0.91;95% CI：-4.62 至 2.79;p = 0.626）、整体功能（MD -2.25;95% CI：-6.70 至 2.20;p = 0.318）、 或严重自残（RR 1.37;95% CI：0.70-2.84;p = 0.335）。与短期 MBT 相比，长期 MBT 组有更多的参与者发生严重不良事件（RR 1.63;95% CI：0.94-3.07;p = 0.088），主要是由于精神病住院率的差异（RR 2.03;95% CI：0.99-5.09;p = 0.056）。 结论 与短期 MBT 相比，长期 MBT 不会导致 BPD 症状水平降低，也不会影响任何次要结局。